Oncology. Objectives. Cancer Nomenclature. Cancer is a disease of the cell Cancer develops when certain cells begin to grow out of control

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1 Oncology Objectives Describe the etiology and pathophysiological mechanisms of cancer Discuss medical and family history findings relevant to cancer Identify general signs and symptoms associated with cancer Identify specific signs and symptoms associated with particular types of cancer Describe the TNM System for staging cancer Discuss presentation, treatment options, prognosis, and survival rates for common types of cancer Cancer Nomenclature Cancer is a disease of the cell Cancer develops when certain cells begin to grow out of control inherit damaged DNA person s DNA can become damaged by environmental factors 1

2 Cancer Nomenclature Abnormal cell growth leads to masses or tumors (neoplasms) Benign (noncancerous) Abnormal accumulations of normal cells Malignant (cancerous) Accumulations of abnormal cells (rapid division) Cancers within the blood and lymph systems may not form tumors, but rather may interfere with the function of normal tissues or cells Cancer Nomenclature Individual types of cancers are named by the organ or tissue of origin Breast cancer Colon cancer Pancreatic cancer Testicular cancer Cancer Nomenclature Cancer that has spread to other organs or tissues is said to have metastasized Common sites for metastasis Spine Lungs Brain Liver 2

3 Cancer Nomenclature Cancer that metastasizes to bone is still named for its tissue of origin not referred to as bone cancer i.e. Metastatic colon cancer When cancer metastasizes, the prognosis is much worse (lower survival rates) General Signs & Symptoms Fever Fatigue Malaise Unexplained weight loss Night symptoms Sweats Pain Other symptoms that wake you at night General Signs & Symptoms Cyclical pain patterns Regular bouts of intermittent pain Pain with normal bodily functions Pain patterns will follow those of normal systemic disease Unusual muscle or joint pain 3

4 Family History Increased risk factor for some cancers Breast Colon Ovarian Personal History Should determine the following characteristics of symptoms Intensity Duration Inspection/Palpation Changes in size or appearance of moles Tender, swollen lymph nodes Visible or palpable masses 4

5 Physical Examination No specific special tests for the athletic trainer to perform Evaluation would be system specific based on symptoms and history Cancer Diagnosis Initial identification Self-exam Medical imaging CT scan MRI Mammogram Bone scan Blood work Serum tumor markers Cancer Diagnosis Confirmation can only be made through tissue biopsy Needle inserted into mass, small piece of tissue withdrawn Tissue examined under microscope Each type of cancer has a specific cellular appearance 5

6 TNM Staging System Once cancer diagnosis made, disease is staged using the TNM System T tumor size Determined via imaging studies, lumpectomy, or surgical resection N involvement of lymph nodes Sentinel node biopsy or resection M metastasis to other organs Identified through imaging studies TNM Staging System Following TNM identification, disease is further staged based on criteria for the specific type of cancer Stages 0 IV TNM Staging System Breast Cancer Stage 0 Noninvasive disease cancer cells have not escaped the area of the breast in which it started Lobular carcinoma in situ (LCIS) Ductal carcinoma in situ (DCIS) A ducts B lobules C dilated section of duct D nipple E fat F pectoralis major G rib cage 6

7 TNM Staging System Breast Cancer Stage I invasive disease cancer cells have escaped into adjacent normal tissue Invasive ductal carcinoma Tumor < 2 cm (1 inch) No node involvement TNM Staging System Breast Cancer Stage II invasive disease cancer cells have escaped into adjacent normal tissue Invasive lobular carcinoma Tumor > 2 cm but < 5 cm Some node involvement TNM Staging System Breast Cancer Stage IIIA invasive disease cancer cells have escaped into adjacent normal tissue Tumor > 5 cm OR significant node involvement 7

8 TNM Staging System Breast Cancer Stage IIIB invasive disease cancer cells have escaped into adjacent normal tissue Cancer involves skin OR Cancer has spread to chest wall TNM Staging System Breast Cancer Stage IV Metastatic disease Cancer Treatment Options Based on the specific type of cancer Based on the staging results Most common Surgery Chemotherapy Radiation Other Stem cells Bone marrow transplant 8

9 Cancer Treatment Options Surgery Not all tumors or cancers are operable In some cases, surgery is the only treatment needed Other cases, surgery will be followed by chemo and/or radiation (adjuvant therapy) in attempt to target any remaining cancer cells Cancer Treatment Options Chemotherapy Oral IV Porta cathether Cancer Treatment Options Chemotherapy Specific cocktail selected based on the specific cancer Number of rounds determined by staging and oncologist s philosophy 9

10 Cancer Treatment Options Chemotherapy Targets and kills fast growing cells It can t tell the difference between normal and abnormal fast growing cells Cancer Treatment Options Chemotherapy Side effects Nausea/vomiting Hair loss Fatigue Inflammation of mucous membranes (mouth, esophagus, stomach) Anemia Suppressed immune system Neuropathy (depending on the drugs used) Cancer Treatment Options Radiation Local effects Administers highenergy x-rays to damage the DNA of cancer cells 10

11 Cancer Treatment Options Radiation Side effects Fatigue Skin reactions Cancer Prognosis 5 year survival rates 10 year survival rates Types of Cancer Breast Testicular Colon Leukemia Hodgkin s lymphoma (Hodgkin s disease) Non-Hodgkin s lymphoma Multiple myeloma Skeletal cancers 11

12 Leukemia Cancer of the bone marrow and blood Leukemia Normally, the bone marrow produces stem cells (immature cells) Stem cells develop into 1 of 3 types of blood cells Red blood cell White blood cell Platelet Leukemia Four Main Types Acute Myeloid Leukemia Stem cells produce too many myeloblasts (immature WBCs) Most common form of acute leukemia in adults Progresses rapidly Can spread to CNS Chronic Myeloid Leukemia Stem cells produce too many granulocytes Occurs most often in middle age (rarely occurs in children) Progresses slowly 12

13 Leukemia Four Main Types Acute Lymphocytic (lymphoblastic) Leukemia Stem cells produce too many lymphacytes Progresses rapidly Can spread to CNS Chronic Lymphocytic Leukemia Stem cells produce too many lymphocytes Occurs most often in middle age 2 nd most common form of adult leukemia Progresses slowly Leukemia Signs & Symptoms Weakness or feeling tired Fever Easy bruising or bleeding Shortness of breath Recurrent infections Weight loss or loss of appetite Pain in the bones Nausea/vomiting Painless lumps in the neck, underarm, stomach, or groin Splenomegaly Hepatomegaly Leukemia Diagnosis Complete blood count (CBC) Bone marrow biopsy Treatment Chemotherapy Bone marrow transplant 13

14 Hodgkin s Disease Cancer that forms in the lymph system Occurs in both adults and children Often metastisizes to liver, spleen, lungs, and bone Hodgkin s Disease Signs & Symptoms Painless, swollen lymph nodes in the neck, underarm, or groin Fever for no known reason Drenching night sweats Weight loss for no known reason Feeling very tired Hodgkin s Disease Diagnosis CBC Lymph node biopsy Treatment Chemotherapy Radiation Bone marrow transplant 14

15 Hodgkin s Disease Prognosis When detected early, 5 year survival rate is 85% Non-Hodgkin s Disease Typically more serious than Hodgkin s disease Two types Fast growing (aggressive) Slow growing Non Hodgkin s Disease Signs and Symptoms Night sweats Fever Unintentional weight loss Swollen lymph nodes Treatment Chemo Radiation Bone marrow transplant 15

16 Multiple Myeloma Cancer that starts in the plasma cells (a type of WBC) Forms tumors in the bone marrow Reduce the normal functioning of the bone marrow Multiple Myeloma Signs and Symptoms Bone pain (particularly in back, hip, & ribs) S/S of anemia Multiple Myeloma Diagnosis CBC Urine tests X-rays Bone marrow biopsy 16

17 Multiple Myeloma Treatment Chemo Radiation Bone marrow transplant Poor prognosis <10% survive 10 years Skeletal Cancers Osteoid osteoma/osteoblastoma Osteochondroma Chondroblastoma Osteosarcoma and chondrosarcoma Osteoid osteoma/osteoblastoma Benign bone tumors Osteoma small Osteoblastoma large (> 2cm) 17

18 Osteoid osteoma/osteoblastoma Most commonly occurs between ages of 7 and 25 More common in men 50-60% of cases occur in femur or tibia 20% of cases occur in hands and feet Slow growing, may take patient months or years to seek medical care Osteoid osteoma/osteoblastoma Signs & Symptoms dull or aching pain, initially mild and intermittent but increasing in intensity and persistence with time (worse at night) Soft tissue swelling and tenderness May cause deformity Osteoid osteoma/osteoblastoma Signs & Symptoms (cont.) Reduced ROM Neurological symptoms if nerve impingement occurs 18

19 Osteoid osteoma/osteoblastoma Treatment Surgical excision Bone stabilization (if needed) Osteochondroma Benign tumor made up of cartilage and bone Most common bone tumor Most commonly occurs at the ends of long bones, near growth plates shoulder knee Osteochondroma Signs & Symptoms hard, immobile, detectable mass that is painless soreness of the adjacent muscles may also be asymptomatic 19

20 Chondroblastoma Benign bone tumor that typically occurs within the epiphysis of long bones Believed to form from immature cartilage cells Common sites Shoulder Hip Knee Chondroblastoma Signs & Symptoms Varies depending on location of tumor Dull ache Atrophy in muscle(s) surrounding involved bone Decreased ROM Chondroblastoma Diagnosis X-ray MRI Treatment Surgical excision Bone grafting when necessary 20

21 Osteosarcoma Malignant bone tumor Most common type of malignant bone cancer Most commonly occurs in metaphysis of long bones 50-80% occur in the knee Most common in males during growth spurt Osteosarcoma Signs & Symptoms Pain, worse at night and with exercise First sign may be fracture due to weakening of the bone Lump or swelling in the area Unexplained limp Osteosarcoma Diagnosis X-ray MRI CT scan 21

22 Osteosarcoma Treatment Surgery (amputation when necessary) Chemotherapy Prognosis 60-80% survival rates when the cancer hasn t metastasized Better prognosis with tumor in extremities, rather than spine, hip, or ribs Chondrosarcoma Malignant bone tumor that originates in cartilage tissue Most commonly involves Arm Spine Hip Femur Chondrosarcoma Signs & Symptoms Pain Possible soft tissue swelling Decreased ROM if tumor is near joint 22

23 Chondrosarcoma Diagnosis X-ray MRI CT scan Biopsy Treatment Surgery Radiation 23